UGANDA’S OPIOID SOLUTION

Processed medications await pick up at the pharmacy on Ellsworth Air Force Base, S.D., Oct. 25, 2011. Pharmacists in the 28th Medical Support Squadron carefully screen all medications to ensure quality product is supplied to their patients.

“No part of our society – not young or old, rich or poor, urban or rural – has been spared this plague of drug addiction and this horrible, horrible situation that’s taken place with opioids,” Trump said during an elaborate and emotional ceremony, attended by American families affected by opioid abuse, “This epidemic is a national health emergency.”

Medical professionals around the world worry about how they can help the 25 million people who die in agony each year in poor and middle-income nations without risking an American-style overdose epidemic abroad or triggering opposition from Western legislators and philanthropists for whom opioid has become a dirty word.

A major study by The Lancet Commission on Global Access to Palliative Care and Pain Relief described a “broad and deep abyss” in access to painkillers between rich and poor countries.

The American delegation to the International Narcotics Control Board, a UN agency, “uses frightening war-on-drugs rhetoric,” said Meg O’Brien, the founder of Treat the Pain, an advocacy group devoted to bringing palliative care to poor countries. “That has a chilling effect on developing countries,” she said. “But it’s ridiculous – the U.S. also has an obesity epidemic, but no one is proposing that we withhold food aid from South Sudan.”

UGANDAN SOLUTION

The only opioid Uganda permits outside hospitals is pint bottles of morphine diluted in water. Liquid morphine is distributed free, at government expense, undercutting incentives for pharmaceutical companies to fight for market share. With doctors in short supply, the law lets even nurses prescribe morphine after specialized training. About 11% of Ugandans needing morphine get it. Inadequate as that is, it makes Uganda a standout not just in Africa, but in the world.

The bottles are a simple and ingenious way to prevent addiction. Getting high would require drinking gallons of the bitter, slightly nauseating solution. Distilling enough morphine to inject would require boiling away gallons.

“You can drink a whole bottle and all you’d get is some nausea and constipation, and be sleepy,” said Rinty Kintu, the Uganda coordinator at Treat the Pain.

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